MEDICARE: SUE ANDERSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	004121	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205937844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUE ANDERSON LCSW

Provider Business Mailing Address
First Line	:	24 MCKINLEY ST
Second Line	:
City	:	NORWALK
State	:	CT
Zip	:	06853-1419
Country	:	US
Telephone Number	:	203-831-0748
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 MCKINLEY ST
Second Line	:
City	:	NORWALK
State	:	CT
Zip	:	06853-1419
Country	:	US
Telephone Number	:	203-831-0748
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	06/28/2010

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Directions to “ SUE ANDERSON LCSW” Practice Location

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